J-1 Visas

J-1 visas enable noncitizen medical graduates to pursue graduate medical education in the United States. The J-1 visa requires individuals who have completed their medical training to return to their home country or country of last origin for at least two years before seeking entry back into the U.S. through a permanent visa. J-1 visa waivers are one mechanism employers in underserved areas can use to attract psychiatrists.

Waivers of this requirement may be granted for the following reasons:

A request is made from an interested U.S. government agency on behalf of the physician. Agencies may include the Department of Health and Human Services (HHS), Veterans Administration (VA), Appalachian Regional Commission (ARC), and state departments of health.

A “hardship” waiver may be granted if the foreign-residence requirement would impose “exceptional hardship” on the physician’s family. This includes instances where the foreign-residency requirement would result in the family’s having to separate and reside in two different countries (relevant for individuals whose spouse is a U.S. citizen or permanent resident or whose children are U.S. citizens) or being able to reside together only in a war torn country. A hardship waiver may also be granted in situations where a family member has a life-threatening illness for which there is no adequate treatment available in the country to which the physician must return.

An “asylum” waiver may be granted in those instances where the Immigration and Naturalization Service (INS) determines the physician is at risk for persecution because of race, religion, or political opinion upon return to his or her country of origin.

In most instances, requests for waivers from U.S. government agencies are made for primary-care physicians and psychiatrists to serve patients in medically underserved areas and in mental health professional shortage areas (HPSAs) as defined by HHS. These waivers are requested by government entities (including employers) on behalf of physicians, not by the physicians themselves. The petitioning health-care agency needs to meet certain criteria and must typically attest that it has been unable to recruit a U.S. physician following an active recruitment process, that the facility is located in a designated underserved area and provides care to Medicare and Medicaid patients, and that the employment contract for the physician granted the waiver will specify a term of full-time employment (40 hours per week) at the designated site for a period of no less than three years. For details, contact the HHS.

Additional Resources

At www.globalhealth.gov, HHS provides regulatory guidance and detailed information on how to apply for a J-1 visa waiver, including guidelines and an application form.